Claims Liaison I
TotalMed Austin, TX
- Expired: over a month ago. Applications are no longer accepted.
We are in need of a medical claims liaison for a well-known health plan in the area.
• Audit check run and send claims to the claims department for corrections
• Identify any system changes and work notify the Plan CIA Manager to ensure its implementation
• Collaborate with the claims department to price pended claims correctly
• Document, track and resolve all plan providers’ claims projects
• Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication
• Identify authorization issues and trends and research for potential configuration related work process changes
• Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes
• Identify potential and documented eligibility issues and notify applicable departments to resolve
• Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc.
• Run claims reports regularly through provider information systems
• Research verbal and written providers’ claims inquiries as needed
Finance and Insurance